TY - JOUR
T1 - Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery
AU - Cahill, Alison G.
AU - Waterman, Brian M.
AU - Stamilio, David M.
AU - Odibo, Anthony O.
AU - Allsworth, Jenifer E.
AU - Evanoff, Bradley
AU - Macones, George A.
N1 - Funding Information:
This work was supported by Grants R01 HD 35631 and K24 HD01289, both from the National Institute of Child Health and Human Development (to G.A.M.).
PY - 2008/7
Y1 - 2008/7
N2 - Objective: The objective of the study was to more precisely estimate the effect of maximum oxytocin dose on uterine rupture risk in patients attempting vaginal birth after cesarean (VBAC) by considering timing and duration of therapy. Study Design: A nested case-control study was conducted within a multicenter, retrospective cohort study of more than 25,000 women with at least 1 prior cesarean delivery, comparing cases of uterine rupture with controls (no rupture) while attempting VBAC. Time-to-event analyses were performed to examine the effect of maximum oxytocin dose on the risk of uterine rupture considering therapy duration, while adjusting for confounders. Results: Within the nested case-control study of 804 patients, 272 were exposed to oxytocin: 62 cases of uterine rupture and 210 controls. Maximum oxytocin ranges above 20 mU/min increased the risk of uterine rupture 4-fold or greater (21-30 mU/min: hazard ratio [HR] 3.92, 95% confidence interval [CI], 1.06 to 14.52; 31-40 mU/min: HR 4.57, 95% CI, 1.00 to 20.82). Conclusion: These findings support a maximum oxytocin dose of 20 mU/min in VBAC trials to avoid an unacceptably high risk of uterine rupture.
AB - Objective: The objective of the study was to more precisely estimate the effect of maximum oxytocin dose on uterine rupture risk in patients attempting vaginal birth after cesarean (VBAC) by considering timing and duration of therapy. Study Design: A nested case-control study was conducted within a multicenter, retrospective cohort study of more than 25,000 women with at least 1 prior cesarean delivery, comparing cases of uterine rupture with controls (no rupture) while attempting VBAC. Time-to-event analyses were performed to examine the effect of maximum oxytocin dose on the risk of uterine rupture considering therapy duration, while adjusting for confounders. Results: Within the nested case-control study of 804 patients, 272 were exposed to oxytocin: 62 cases of uterine rupture and 210 controls. Maximum oxytocin ranges above 20 mU/min increased the risk of uterine rupture 4-fold or greater (21-30 mU/min: hazard ratio [HR] 3.92, 95% confidence interval [CI], 1.06 to 14.52; 31-40 mU/min: HR 4.57, 95% CI, 1.00 to 20.82). Conclusion: These findings support a maximum oxytocin dose of 20 mU/min in VBAC trials to avoid an unacceptably high risk of uterine rupture.
KW - oxytocin
KW - uterine rupture
KW - vaginal birth after cesarean
UR - http://www.scopus.com/inward/record.url?scp=45649084879&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2008.03.001
DO - 10.1016/j.ajog.2008.03.001
M3 - Article
C2 - 18455132
AN - SCOPUS:45649084879
SN - 0002-9378
VL - 199
SP - 32.e1-32.e5
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 1
ER -